Vice Presidential Debate: Two Visions For Medicare

By Kaiser Health News Staff

Vice President Joe Biden (Democrat) and Rep. Paul Ryan (Republican) laid out their parties' competing visions for Medicare at the televised vice-presidential debate in Danville, Ky., Thursday. Here's what they said.

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Both Medicare and Social Security are going broke
and taking a larger share of the budget in the process. Will benefits for
Americans under these programs have to change for the programs to survive, Mr.
Ryan?

Rep. Candidate PAUL RYAN: Absolutely.
Medicare and Social Security are going bankrupt. These are indisputable
facts.

Look, when I look at these programs, we've all had
tragedies in our lives. I think about what they've done for my own family. My
mom and I had my grandmother move in with us who was facing Alzheimer's.
Medicare was there for her, just like it's there for my mom right now who's a
Florida senior. After my dad died, my mom and I got Social Security survivors
benefits. Helped me pay for college. It helped her go back to college in her
50s, where she started a small business because of the new skills she got. She
paid all of her taxes on the promise that these programs would be there for
her. We will honor this promise.

And the best way to do it is reform it for my
generation. You see, if you reform these programs for my generation, people 54
and below, you can guarantee they don't change for people in or near
retirement, which is precisely what Mitt Romney and I are proposing.

Look at Obamacare does. Obamacare takes $716
billion from Medicare to spend on Obamacare. Even their own chief actuary at
Medicare backs this up. He says you can't spend the same dollar twice. You
can't claim that this money goes to Medicare and Obamacare.

And then they put this new Obamacare board in
charge of cutting Medicare each and every year in ways that will lead to denied
care for current seniors. This board, by the way, it's 15 people. The
president's supposed to appoint them next year. And not one of them even has to
have medical training.

And Social Security, if we don't shore up Social
Security, when we run out of the IOUs, when the program goes bankrupt, a 25
percent across-the-board benefit cut kicks in on current seniors in the middle
of their retirement. We're going to stop that from happening.

They haven't put a credible solution on the table.
He'll tell you about vouchers. He'll say all these things to try and scare
people.

Here's what we're saying: Give younger people, when
they become Medicare-eligible, guaranteed coverage options that you can't be
denied, including traditional Medicare.

Choose your plan, and then Medicare subsidizes your
premiums, not as much for the wealthy people, more coverage for middle-income
people and total out-of-pocket coverage for the poor and the sick. Choice and
competition — we would rather have 50 million future seniors
determine how their Medicare is delivered to them instead of 15 bureaucrats
deciding what — if, where, when they get it.

RADDATZ: Vice
President Biden, two minutes.

VICE PRESIDENT JOE
BIDEN: You know, I heard that death panel argument from
Sarah Palin. It seems that every vice presidential debate, I hear this kind of
stuff about panels. But let's talk about Medicare.

What we did is we saved $716 billion and put it
back — applied it to Medicare. We cut the cost of Medicare. We
stopped overpaying insurance companies when doctors and hospitals —
the AMA supported what we did. AARP endorsed what we did. And it extends the
life of Medicare to 2024. They want to wipe this all out. It also gave more
benefits. Any senior out there, ask yourself: Do you have more benefits today?
You do. If you're near the doughnut hole, you have $600 more to help your
prescription drug costs. You get wellness visits without copays. They wipe all
of this out, and Medicare goes — becomes insolvent in 2016, number
one.

Number two, guaranteed benefit — it's a
voucher. When they first proposed — when the congressman had his
first voucher program, the CBO said it would cost $6,400 a year, Martha, more
for every senior 55 and below when they got there. He knew that, yet he got it —
all the guys in Congress, and women in the Republican party to vote for it.
Gov. Romney, knowing that, said, I would sign it were I there. Who you believe,
the AMA? Me? A guy who's fought his whole life for this? Or somebody who had
actually put in motion a plan that knowingly cut — added $6,400 a
year more to the cost of Medicare?

Now they got a new plan. Trust me, it's not going
to cost you any more. Folks, follow your instincts on this one.

And with regard to Social Security, we will not
privatize it. If we had listened to Gov. Romney and the congressman during the
Bush years, imagine where all those seniors would be now if their money had
been in the market. Their ideas are old, and their ideas are bad, and they
eliminate the guarantee of Medicare.

RYAN: Here's the
problem. They got caught with their hands in the cookie jar turning Medicare
into a piggy bank for Obamacare. Their own actuary from the administration came
to Congress and said one out of six hospitals and nursing homes are going to go
out of business as a result of this.

BIDEN: That's
not what they said.

RYAN: Seven
point four million seniors are projected to lose the current Medicare Advantage
coverage they have. That's a $3,200 benefit cut.

BIDEN: That
didn't happen.

RYAN: What
we're saying —

BIDEN: More
people signed up.

RYAN: These
are from your own actuaries.

BIDEN: More
people signed up for Medicare Advantage after the change.

RYAN: What
they're —

BIDEN: No,
nobody is getting shut down.

RYAN: Mr.
Vice President, I know —

BIDEN: No —
no —

RYAN: Mr.
Vice President, I know you're under a lot of duress to make up for
lost ground, but I think people would be better served if we don't keep
interrupting each other.

BIDEN: Well,
don't take all the four minutes, then.

RYAN: Now let
me say this. We are saying, don't change benefits for people 55 and above. They
already organized their retirement around these promises.

BIDEN: They
already are —

RYAN: But you
want to — these programs for those of us —

RADDATZ: Let
me ask you this: what is your specific plan for seniors who really can't afford
to make up the difference in the value of what you call a premium support plan
and others call a voucher?

RYAN: A
hundred percent coverage for them.

RADDATZ: And
what —

RYAN: That's
what we're saying.

RADDATZ: How
do you make that up?

RYAN: So
we're saying income-adjust these premium support payments by taking down the
subsidies for wealthy people. Look, this is a plan — by the way, that
$6,400 number, it was misleading then. It's totally inaccurate now. This is a
plan that's bipartisan. It's a plan I put together with a prominent Democrat
senator from Oregon.

BIDEN: There's
not one Democrat who endorsed this —

RYAN: It's a
plan —

BIDEN: —
not one Democrat who signed his plan.

RYAN: Our
partner is a Democrat from Oregon.

BIDEN: And he
said he does no longer supports —

RYAN: We put
it together with the former Clinton budget director.

BIDEN: Who
disavows it.

RYAN: This
idea — this idea came from the Clinton commission to save Medicare,
chaired by Sen. John Breaux. Here's the point, Martha.

BIDEN: Which
was rejected.

RYAN: If we
don't fix this problem pretty soon, then current seniors get cut.

Here's the problem. Ten thousand people are retiring
every single day in America today, and they will for 20 years. That's not a
political thing. That's a math thing.

BIDEN: Martha,
if we just did one thing, if they allow Medicare to bargain for the cost of
drugs like Medicaid can, that would save $156 billion right off the
bat.

RYAN: And it
would deny seniors choices.

BIDEN: Seniors
are not denied.

RYAN: Absolutely.

BIDEN: Sorry,
they are not denied.

Look, folks, and all you seniors out there, have
you been denied choices? Have you lost Medicare Advantage or, if you have
signed up —

RYAN: Because
it's working well right now.

BIDEN: Because
we changed the law.

RADDATZ: Vice
President Biden, let me ask you, if it could help solve the problem, why not
very slowly raise the Medicare eligibility age by two years, as Congressman
Ryan suggests?

BIDEN: Look,
I was there when we did that with Social Security, in 1983. I was one of eight
people sitting in the room that included Tip O'Neill negotiating with President
Reagan. We all got together, and everybody said, as long as everybody's in the
deal, everybody's in the deal, and everybody is making some sacrifice, we can
find a way. We made the system solvent to 2033.

We will not, though, be part of any voucher plan
eliminating — the voucher says, Mom, when you're 65, go out there,
shop for the best insurance you can get, you're out of Medicare. You can buy
back in, if you want, with this voucher, which will not keep pace with health
care costs, because if it did keep pace with health care costs, there would be
no savings. That's why they go the voucher. We will be no part of a voucher
program or the privatization of Social Security.

RYAN: A
voucher is you go to your mailbox, get a check and buy something. Nobody's
proposing that. Barack Obama, four years ago, running for president, said if
you don't have any fresh ideas, use scare tactics to scare voters. If you don't
have a good record to run on, paint your opponent as someone people should run
from. Make a big election about small ideas.

RADDATZ: You
were one of the few lawmakers to stand with President Bush when he was seeking
to partially privatize Social Security.

RYAN: For
younger people. What we said then and what I've always agreed is let younger
Americans have a voluntary choice of making their money work faster for them
within the Social Security system.

BIDEN: You
saw how well that worked.

RYAN: That's
not what Mitt Romney's proposing. What we're saying is no changes for anybody
55 and above.

BIDEN: What
Mitt Romney is proposing —

RYAN: And
then the kinds of the changes we're talking about for younger people like
myself is don't increase the benefits for wealthy people as fast as everybody
else —

BIDEN: Martha
—

RYAN: —
slowly raise the retirement age over time.

BIDEN: Martha
—

RYAN: It wouldn't
get to the age of 70 until the year 2103, according to the actuaries.

Now, here's the issue.

RADDATZ: Quickly,
Vice President.

BIDEN: Quickly,
the bottom line here is that all the studies show that if we went with Social
Security proposal made by Mitt Romney, if you're 40 — in your 40s
now, you will pay $2,600 a year — you get $2,600 a year less in
Social Security.

If you're in your 20s now, you get $4,700 a year
less. The idea of changing — and change being, in this case, to cut
the benefits for people without taking other action you could do to make it
work — is absolutely the wrong way.

These guys haven't been big on Medicare from the
beginning. Their party's not been big on Medicare from the beginning. And
they've always been about Social Security as little as you can do. Look, folks,
use your common sense. Who do you trust on this? A man who introduced a bill
that would raise it $6,400 a year, knowing it and passing it, and Romney saying
he'd sign it? Or me and the president?

RYAN: That
statistic was completely misleading. But more importantly —

BIDEN: That's
— there are the facts, right?

RYAN: —
this is — this is what politicians do when they don't have a record
to run on: try to scare people from voting for you. If you don't get ahead of
this problem, it's going to —

BIDEN: Medicare
beneficiaries have more benefits now —

RYAN: We are
not going to run away — we are not going to run away —

RADDATZ: OK.
We're going to — we're going to move on to a very simple question to
you both.

RYAN: Medicare
and Social Security did so much for my own family. We are not going to
jeopardize this program, but we have to save it for the next generation so it
doesn't go bankrupt.

BIDEN: You
are jeopardizing the program. You're changing the program from a guaranteed
benefit to a premium support. Whatever you call it, the bottom line is people
are going to have to pay more money out of their pocket.

RYAN: The
wealthy would.

BIDEN: And
the families I know and the families I come from — they don't have
the money to pay more out of —

RADDATZ: Gentlemen,
gentlemen —

RYAN: That's
why we're saying more for lower-income people and less for higher-income
people.

RADDATZ: I
would like to move on to a very simple question for both of you. And something
tells me —

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